Fluoroscopy is a method of performing X-ray fluoroscopic medical diagnostic procedures. Fluoroscopic procedures include upper GI series, contrast enema studies, esophagography, voiding cystourethrography, T-tube cholangiography, sinography, chest fluoroscopy, and a wide variety of other medical procedures.
Fluoroscopy can be used to perform videofluoroscopy or to obtain spot-films. Videofluoroscopy creates a full motion X-ray video image, and is used to diagnostically evaluate dynamic physiological processes such as swallowing, bowel motion, and other physiological processes involving temporal factors. This live videofluoroscopic image is also used to monitor the adequacy of contrast administration, which involves the use of various X-ray opaque chemical compounds injected into the patient. Videofluoroscopy is also useful to optimize "spot" filming for documentation of both normal and abnormal findings. The fluoroscopic X-ray administration to the patient is controlled by a radiologic professional who is physically present at the site where the fluoroscopic examination occurs. When insufficient demand for radiologic medical services to economically support a full-time radiologist. This situation will be exacerbated by increasing service demands on radiologists, and declining professional reimbursement by government agencies. Due to these economic factors, many rural/small health care facilities staffed with part-time radiologist are now facing the prospect of elimination of, or decreased access to, radiological services.
Lack of access to radiological services in rural communities and smaller hospitals will inevitably result in a decreased ability to provide these services in a timely fashion. Reliance on part-time radiologists can lead to delays in performing radiologic examinations, and in the case of emergencies, may necessitate transporting the patient to a medical facility with a radiologist immediately available. The inability to provide timely radiologic services will result in increased costs to the patient, loss of revenue to the health care facility from which the patient must be transported, and delayed diagnosis and treatment.
Faced with these problems, the commonly proposed solution is to utilize non-physicians to perform the initial radiologic procedures, with a radiologist later viewing the X-ray films obtained, either directly or via teleradiology equipment, and perhaps viewing videotape of the videofluoroscopic portion of these procedures. This proposed solution is not optimal for patient care.
The proposed non-physician fluoroscopists (radiologic technologists) lack the medical training, knowledge, and expertise required to properly perform these procedures. At present there is not an approved course of study for non-physicians to gain these skills which are acquired by radiologists through medical school and at least four years of post-doctoral training. Consequently, findings apparent to the radiologist at the time of fluoroscopy may not be apparent to the non-radiologist resulting in lack of filming and thereby identification of significant abnormalities. This may result in missed or delayed diagnoses and compromise patient outcomes. Lack of expertise may also increase examination time and thus unnecessarily increase radiation exposure to the patient.
A real-time diagnostic telefluoroscopy system would provide continuous remote radiologist staffing and thereby continuous fluoroscopy availability to underserved health care facilities. Patients would benefit by timely diagnosis and expedited treatment at their local health care facility, access to expert professional diagnostic services, decreased transportation costs, and by being able to receive these services in their local health care facility. Underserved health care facilities would benefit by being able to retain patients and patient revenue, thus enabling them to offer a wider range of higher quality medical services to their communities.
Prior to the general commercial availability of high volume telecommunications circuits, telefluoroscopy was not possible because available telecommunication links were not capable of handling the volume of data and video signal transmission necessary to generate live telecommunications transmitted fluoroscopic images which are diagnostically usable.
Existing medical video telecommunication transmission applications are capable of transmitting diagnostic video images, typically as part of ultrasonographic examinations, at the maximum of 288 lines of horizontal resolution at 30 frames per second. The spatial resolution of an ordinary fluoroscopic device is equal to or greater than approximately 500 lines of horizontal resolution and a temporal resolution of 30 frames per second.
It would be desirable, therefore, to have a diagnostic telefluoroscopy system and a method of performing telefluoroscopy utilizing a high volume telecommunications circuit capable of transmitting and receiving a video signal with a horizontal resolution of at least 480 lines and a temporal resolution of at least 30 frames per second. This level of spatial and temporal resolution would result in no significant image degradation compared to on-site fluoroscopic video output.
It would also be desirable to achieve this level of spatial and temporal resolution for live telecommunications transmitted ultrasonographic images, an image quality far superior to current ultrasonographic images transmitted by telecommunications circuits.
Finally, it would be desirable to provide a combined system and method of telefluoroscopy, teleradiology and ultrasonography so that a patient could undergo all, or any combination of these procedures, while radiologic professional at the patient examining site is in direct communication with a radiologist at a remote site who is viewing, interpreting and controlling the examination procedures.